pharmacy.photon.health Open in urlscan Pro
13.32.121.51  Public Scan

Form analysis
1 forms found in the DOM

POST /view

<form action="/view" method="post">
  <div style="padding: 2px;">
    <label class="label-claim" for="secure_key">Secure Key</label>
    <input class="border input-claim" type="text" id="secure_key" name="secure_key" style="" value="">
  </div>
  <div style="padding: 2px;">
    <label class="label-claim" for="last_name">Patient Last Name</label>
    <input class="border input-claim" type="text" id="last_name" name="last_name" value="" style="">
  </div>
  <div style="padding: 2px;">
    <label class="label-claim" for="birth_date">Patient Birth Date</label>
    <input class="border input-claim" type="date" id="birth_date" name="birth_date" style="" value="">
  </div>
  <br>
  <button style="padding: 2px; min-width: 6rem;" class="button-accept"> View Order </button>
</form>

Text Content

PRESCRIPTION REQUEST



A PROVIDER HAS SENT YOU A DIGITAL PRESCRIPTION VIA PHOTON. AUTHENTICATE USING
THE INFORMATION PROVIDED ON THE NOTIFICATION SENT TO YOUR PHARMACY.


Enter key and patient information

Secure Key
Patient Last Name
Patient Birth Date

View Order
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